The candidate, Kevin M. Terrell, DO, MS, is an emergency physician at the Indiana University Department of Emergency Medicine who is committed to a career in geriatrics health services research. The environment includes the Wishard Emergency Department, the ILJ Center for Aging Research, and three local nursing homes. Dr. Terrell's immediate career goal is to obtain the expertise needed to develop as an independent scientist in aging research. Completion of this goal will provide the foundation for his long-term goal to improve the emergency care of nursing home residents through research and leadership. The career development plan includes quality improvement and organizational change, quality indicator validation training, advanced clinical research methods, and leadership training; clinical research under the supervision of successful, independent scientists; and a yearlong experience providing primary care to nursing home residents. This plan will position Dr. Terrell to accomplish his career goals. The emergency department is a major provider for nursing home residents, yet our research and clinical experience demonstrate that transfers between the two sites of care are in great need of quality improvement. Furthermore, the limited success of seemingly promising interventions points to the need for methodical, yet efficient, development of capable interventions before introducing new interventional strategies. The purpose of the proposed research is to provide such fundamental research underpinning future interventional efforts. We previously identified a set of quality indicators for transfers between nursing homes and emergency departments through working with two groups of national leaders in geriatric emergency care. The two specific aims in the proposed research are (1) to validate the quality indicators for transfers of care and (2) to plan the formal testing of an intervention to improve the emergency care of nursing home residents. The expected outcomes of the proposed research are a valid set of quality indicators that we (and others) will use to develop interventions and judge their effectiveness in clinical trials as well as a submitted R01 application to support a future clinical trial. We are focusing the research plan to discover the most promising opportunities for quality improvement. With his commitment to this area of research and his strong research team, Dr. Terrell will be well prepared to conduct the research proposed in this application, to investigate the subsequent interventional trial, and to become a leader in geriatric emergency medicine research in the process. RELEVANCE (See instructions): The relevance to public health is that this research seeks to improve the quality of emergency care delivered to nursing home residents, a highly vulnerable group. Further, we seek to improve their care at a particularly high-risk point, during transfers of care. [unreadable] [unreadable] [unreadable]